Anyone working outdoors, like those who earn their living maintaining golf courses, needs to be familiar with the signs and risks of heat-related illnesses.

Dr. Sean A. Cupp, a sports medicine specialist with University Hospitals in Cleveland, offers insights on the warning signs to look for in your maintenance crew, and why people are at greater risk for heat-related illnesses than others.

What are the symptoms of heat exhaustion and heatstroke?Dr. Cupp: The symptoms are going to be very similar between the two. They include a rapid heart rate, hyperventilation, heavy sweating, starting to experience a headache, dizziness, fatigue, irritability, anxiety or confusion, and possibly nausea, vomiting, and chills.

The main differences between the two is the core body temperature When it becomes equal to or higher than 105 degrees, that is heatstroke. If it's 104 degrees or below with those symptoms, that's what we would label as heat exhaustion.

We look at this as a continuum, beginning with heat cramps and progressing to heat exhaustion to heat stroke and then potentially death.

Are there factors that make certain people more susceptible to heat-related illnesses than others?There are some individual risk factors that really contribute to this, including obesity, dehydration, fatigue, having a low fitness level, having a recent heat illness or current illness, and not being acclimated to the environment. And then there are multiple medications which can also put you at a higher risk.How important is hydration and rehydration?We really stress rehydration. What's really important is to have 16-18 ounces of fluids about two hours before you start your activity and then another eight ounces about 30 minutes before you start your activity.

When you start talking about getting "tanked up" the night before, that's not a bad thing. But pretty much everything you put in your going to lose through urination before the next day. But it's not a bad thing to have a full tank.

The thing you don't want to do is drink a lot of alcohol the night before, or a lot of caffeine the morning of and then go spend the day out in the heat because both of those are diuretics that will dehydrate you.

In addition to water, a lot of people rely on electrolyte drinks such as Gatorade. How effective are those drinks in preventing dehydration?I recommend if your activity is moderate to intense and lasts over an hour, then you should probably replace fluid with something that has salt and sugar in it -- like Powerade or Gatorade. If the activity lasts an hour or less, water is the best thing to replace fluid loss. But for anything over an hour you should probably replace 12-24 ounces per hour of activity. If you're going to be out for four hours, then you probably are going to want 48-96 ounces of (replacement fluids), a minimum 50 percent of that being Gatorade and the other 50 percent could be water.

Can heat illness occurs when the weather is not oppressively hot?Yes, it does not have to be an extremely hot environment. We gain heat and lose heat through conduction and radiation. There are multiple ways our bodies can heat up and cool off.

If you're in a moderate-temperature environment with high humidity you're at a much greater risk of having a heat illness than if you were in a low-humidity, high-heat environment. At that point, you're thinking “I need to be replacing my fluids.” If you're in a high-humidity environment with a moderate temperature, you're probably not going to think about replacing your fluids as much.

Are there certain medications that can accelerate the dehydration process?The big ones are anything that is going to decrease your sweating output and alters how your body produces heat. The big ones are antihistamines. A lot of people take those when they go out onto a golf course and work outside to control allergy symptoms.

Caffeine, any type of diuretic, any type of water pill. A lot of blood-pressure pills are diuretics that help the body get rid of excess fluid.

A lot of people -- especially athletes -- are being treated for ADHD. Those (medications) are basically stimulants and the stimulants can alter the heat production of the body.

Know when to say when

Superintendent Gene Scarborough educates his laborers on the importance of heat safety and why it’s important to know when to get from the sun.

While the bulk of the play at the 36-hole Cooper Resort in Santee, S.C., takes place over 10-12 weeks in the spring from March into May, and then again over six or seven weeks from mid-September into November, the facility remains open during the summer months when temperatures might exceed 100 degrees and the heat index approaches 120.

Scarborough does his best to make things bearable for his team, which consists of 15 full timers during peak season, by adjusting the work schedule during hot weather.

“Normally we come in at 6 a.m. and work to 2:30 p.m.,” he says. “Sometimes in really hot weather we’ll knock off at noon because by 11 in the morning it’s stifling and you don’t want to be here anymore.”

Some workers will return in the late afternoon and work for several hours into the evening if there are issues that need attention, Scarborough says. Because his team’s average age is older than at many other facilities, he says it’s particularly important that everyone keep an eye on each other in extreme weather.

“We all have radios,” he says, “And I put people in pairs. That way, if something were to happen to somebody, somebody is right there with them.

Prior to the extreme weather setting in at the start of the summer, Scarborough has his team review an online video that addresses heat safety concerns and includes an online questionnaire. To further reduce the risk to his workers, he recently purchased new mowers with Cool-It tops. He’ll also mount umbrellas on his mowers from time to time and utilizes covers on his utility carts.

He also encourages his team to take breaks when they need them. “When its super, super hot I tell the guys to work 45 minutes and then take a 15-minute break in the air conditioning or the shade,” he says, “just to get out of the sun.”

Lastly, Scarborough reminds his team about the importance of staying properly hydrated. “You always have to be drinking fluids,” he says.

Scarborough himself prefers a blend of Gatorade or Powerade mixed with water, or else water flavored with a small amount of fruit juice.

“You’ve got to be proactive,” he says. “If we come in in the morning and we know it’s going to be wicked hot, we remind the guys to start drinking.”

Full of it

Full of water, that is. Proper hydration and cool-down opportunities are ways superintendent Matt Herstad keeps his crew out of danger on hot days.

Some might not consider the Midwest as a region where heat-related illnesses are a summertime concern. But that thinking couldn’t be further from the truth.

For example, temperatures in the Chicago area during the summer months regularly will reach the low 90s. As recently as last summer the region experienced 10 straight days of 90-plus degree weather. Occasionally, about every two or three years, the temperature soars beyond 100 degrees for a brief period

Matt Harstad, superintendent at Calumet Country Club in Homewood, Ill., is quick to point out that in the Chicago-land area, as in much of the Midwest, the humidity is a significant concern. Harstad does his best to see that his team completes the most physically demanding work during off-peak hours.

“Depending on what’s on going on, we’ll try to all of our walk mowing and more strenuous work first thing in the morning,” he says of his staff of 14s. “And then we try to give the guys less strenuous jobs or maybe jobs in the shade a little bit more, or riding machines when it gets hotter in the afternoon so they’re not as prone to be getting worn out.”

New employees are shown a video dealing with heat-safety issues and veteran staffers occasionally get a refresher course on the subject, but Harstad relies primarily on a common-sense approach.

“We have one of those five-gallon water coolers in the guys’ lunchroom so they always have easy access to water,” he says. “On the days that its really warm I really stress in the mornings that they drink a lot of water during the day.”

Hydration is Harstad’s mantra during oppressively warm weather.

“I try to stress on (summer) mornings that everybody drink a lot of water,” he says. “Sometimes I’ll see them drinking a bunch of pop (soda/soft drinks) and I’ll tell then that’s not helping. You need to drink water and at times I’ll go up to the clubhouse and get 15 Gatorades so everyone can have Gatorade on those days.”

But Harstad says most of his team knows to take the proper precautions against the heat. “Most of the guys will carry gallon water jugs with them on hot days,” he says. “And they’ll drink a ton of water when it’s hot. They’re pretty good about it on their own.”

During the summer months, Harstad installs a window air conditioner in the lunchroom. He also encourages members of his team to take breaks when they need it.

“I always stress if they’re not feeling well on those hot days they’re welcome to come inside, take 10 minutes and cool off before they go back out,” he says.

Harstad says he’s fortunate a member of his team has never become stricken with heatstroke.

“The most major situation we ever had was a guy got a little dizzy,” he says. “We just brought him inside, he drank a bunch of water and cooled off and then we kind of let him stay inside for the rest of the day.”

Common sun sense

Employing experience and common sense are two cornerstones for keeping laborers safe in high heat and humidity.

While Tim Hiers, CGCS, doesn’t have a formal training program for his team, but when it comes to heat-related issues he preaches the ‘Gospel of Good Judgment’ to his team with the gusto of a tent revival minister.

“It’s just experience and common sense,” says Hiers, the director of agronomy at the Club at Mediterra. "Most of our guys on our crew have been working on golf courses a long time."

Hiers has spent 47 years in the golf industry, including 41 as a superintendent. He’s spent his entire career in Florida; In May, he completed his second year at The Club at Mediterra in Naples where he oversees the care and conditioning of 36 holes.

For the most part, the crew takes Hiers’ philosophy to heart.

“The guys you’ve got to watch are the young guys," Hiers says. "I had a guy about 15 years ago who had heatstroke on the golf course. It was a scary thing. It was a young, very fit guy who thought he was indestructible. There was no permanent damage, but it was scary. I’d never seen anything that bad, that close up.”

During the summer months, temperatures in and around Naples reach between 93-97-degree daily. Throw in the oppressive humidity and it is easy to understand how and why Hiers has developed an assortment of strategies for coping with the heat.

Some years ago, while employed at another club, Hiers and his crew were regrassing greens.

“We switched the crews out to prevent heatstroke,” he says. “Lifting the old sod off those greens was very, very strenuous. The crews got frequent rests, we had sufficient manpower but we were highly cognizant of the potential for back injury and heat stroke.”

In addition to water and Gatorade, the crews were provided with fruit, including apples, peaches, and grapes.

Hiers makes it a point to communicate with his grounds team about the dangers of hot weather. “If we know it’s going to be 98 degrees we’ll talk to the guys,” he says. “We remind them to stay hydrated. “

Like other superintendents, Hiers make sure the members of his team are never working in isolation. “Nobody really works by themselves,” he says. “There’s always somebody with somebody.”

Of course, some jobs are more strenuous than others and require a different level of supervision.

“If you’re just changing cups, you’re not likely to have an issue,” Hiers says. “But if you’re out doing something more physical where you’re burning more calories and maybe you’re not taking water in like you should, then we’ve got closer eyes on that.”

Look before you leap

Thinking about pursuing a new job? Tim Moraghan explains why you should proceed with caution.

Whenever my phone rings, I wonder who it will be: a potential client or a superintendent unhappy in his current job and looking for my advice on their next move.

Job dissatisfaction isn’t limited to our profession. But given that we are on the front lines in a people-pleasing industry and, as I’ve written before, we get the short end of the stick when it comes to customer appreciation. The usual reasons remain the same:- Money (not being paid enough)- Lack of appreciation for one’s efforts from members and/or management- Unpleasant work environment- Differences of opinion with management about direction of the club or facility- The thrill, or challenge, is gone

That’s when the voice on the other end of the line says something like, “So I’m thinking maybe it’s time to go somewhere else.”

You may be right. Maybe you should get another job at another club. And there could be a hundred great reasons to do so. However, before going too far down that path I have some advice: Be honest with yourself.

Before you do anything, conduct a self-evaluation of yourself, your current job, what you think another job will do for you and much more. Take the emotion out of the process and look at all sides of the situation. There are right and wrong reasons to change jobs, but don’t do so with your eyes wide shut.

Start by asking yourself these questions. And spend a good amount of time thinking about each one:- Why do I want to leave my present job? - How much disruption would it be to my life and my family? Will it be worth it?- Are my relationships with the GM, golf pro, and members that bad? Do I want to have to form new ones?- Do I want to take a leap into the unknown?- Is the grass really greener somewhere else?

If you’ve honestly asked and answered those questions (and dozens more you can come up with) and still want to change jobs, great. By all means, go for it. How? You can check job boards and send out resumes, but be careful. Even a casual inquiry to a friend can get back to your current club and have negative ramifications. Which might not be a bad thing, but could accelerate your departure.

Ask yourself what you want out of a new gig: More money? More responsibility? Less hassle? Remember, life is a trade-off: What are you willing to give up to get any of those?

When you start talking to other clubs, be ready to ask yourself more questions, including:- Am I good enough to do this job? (This is probably the toughest question, so be really honest with yourself. And it might not be are you good enough, but are you ready and willing to prove yourself again?)- Can I handle the extra pressures that come with a new, probably upgraded position?- How will this job change my personal situation?

Think about family. If you have kids in school, especially high school, do you want to relocate them? Will they be able to handle it? Check out the schools in the new area before talking seriously with a new club.

What about your spouse? If you are currently in a situation that’s running well so you can get home for dinner, soccer games or holidays, consider what will happen if that changes with the new job? Not only changes to your free time, but who is going to have to pick up the responsibilities you can’t? Will your spouse be able to find a job in the new area or would your spouse need to give up a terrific position?

Turning the family question on its head, I recently talked to a superintendent who took a job in a different state but six months in knew he’d made the wrong decision. However, his family is happy in the new location—schools, neighborhood, friends, church. He’s in a bind.

How about spare time? Consider your involvement in the community, charities or whatever is important to you when you’re not at the club. These activities make you a well-rounded, fulfilled person. Are you ready to give up the ones you do now? Will you be able to commit yourself to such projects in the new job? Factor flexibility and quality of life into the equation when appraising a new opportunity.

Something else we don’t talk enough about: Age. If you’re 50-plus, do you really want a job that takes you away from your family, your spouse, your hobbies? Will you have the energy to dedicate to a new job at this point in your career? Here’s a tough one: Are you healthy enough to take on a new assignment? It saddens me to see what this job has done to many of us and our health.

Don’t change jobs simply because you’re angry or “don’t get enough respect.” What are you angry about? Are these insurmountable obstacles or can they be resolved in open discussions with management, board members, or others you work with? Are any of these problems significant enough to make you want to leave and start over? Would you just be running away from problems likely to confront you at the next place?

It’s very tough out there. Simply saying you want a new job doesn’t mean you’re going to get one, especially not one that has everything you want — money, responsibility, respect.

If you have job security (whatever that is these days) where you are now, don’t be too quick to throw it away. What happens if you fail at the new job, or, like the example above, it isn’t what you thought it would be? Will you be able to get your old job back? Don’t count on it.

If there is a new job, how do you know it will be better? There’s a lot of due diligence before going for the interview or signing a letter of intent.Do your research. Don’t make a decision solely on the people you meet, good or bad. Ask the new club for whatever information it is willing to give. You can learn a lot about a place by what they’re willing to share and what they hold back. At the very least, you should expect to learn about operating procedures, policies, budgets, reports, membership information, club history and traditions. Scour the internet for whatever else you can find.

Talk to salespeople, other superintendents in the area, industry professionals (architects, consultants, builders) for additional perspective on the club. And if the club is open-minded, ask to speak to some members, and not just about what they think of the course conditions.

Will they let you talk to other employees? Not just on the grounds crew but the head pro, chef, controller. Call the previous superintendent: Why did he/she leave? Where are the land mines? Of course, you may have to take this information, assuming it’s given, with a large grain of salt.

Sometimes a new job is the right answer. But not unless you’ve asked all the right questions.

Tim Moraghan is the principal of ASPIRE Golf and a regular GCI columnist.